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EXTERN
CONFERENCE
Ext วงศธร โรจนไพฑูรย์ PCM
Case
 ผู้ป่วยเด็กชายไทยอายุ5ปี
 Chief complain: ปวดข้อศอกซ้าย 2hr PTA
 Present illness: 2hr PTAขณะวิ่งเล่นกับเพื่อน แล้วล้มถูกเพื่อน
ทับที่ศอกซ้าย เหยียดศอกไม่ได้ งอไม่ได้ เนื่องจาก ปวดมากทันที ข้อศอก
บวม ไม่มีบาดแผลภายนอก
Primary surway
 Airway: can talk no stridor, no c-spine
tenderness
 Breathing :normal and equal breath sound
 Circulation: no active bleed BP 150/80 mmHg
HR 112 bpm
 Disability: pupil 2 mm RTLBE E4V5M6
 Exposure: no back wound
Secondary surway
 Allergy :ไม่แพ้ยาแพ้อาหาร
 Medication:ไม่มียากินประจา
 Past history:ไม่มีโรคประจาตัว
 Last meal:3 hr PTA
 Event: as above
Physical exam
 V/S BT 36.5c BP 150/80 mmHg RR 20/min PR
112 bpm
 elbow in slight flexion and forearm pronated
 Left elbow tender at lateral side with limit ROM
all direction ,no contusion ,no wound ,no
swelling
 Shoulder joint not tender full ROM
 Can full flexion and extension finger
 Radial artery pulse 2+
 Intact sensation Lt arm
Differential diagnosis
 Radial Head subluxation
 Supracondylar fractures
 Lateral condylar physeal fractures
Anatomy
Anatomy
Anatomy
Anatomy
Film Elbow Both elbow AP
Film Elbow Both elbow Lateral
Nursemaid's Elbow
 Also known as subluxation of radial head
 Epidemiology
 most common in children from 2 to 5 years of age.
 Pathophysiology
 mechanism
 caused by longitudinal traction applied to an extended arm
 pathoanatomy
 caused by subluxation of the radial head and interposition of
the annular (orbicular) ligament into the radiocapitellar joint
 PresentationSymptoms
 a child with radial head subluxation tends to hold
the elbow in slight flexion and the forearm
pronated.
 Physical Exam
 pain and tenderness localized to the lateral
aspect of the elbow.
pathophysiology
pathophysiology
treatment
video
Post reduction
Post treatment
 Recurrence occurs in 5% to 39% of cases, but
generally ceases after 5 years of age.
 immobilization is not necessary and the child
may immediately resume use of the arm.
 follow up is only needed if the child does not
resume normal use of his arm in the following
weeks.
reference
Rockwood and Wilkins Fracture in
Children
https://www.orthobullets.com/pediatrics/
4012/nursemaids-elbow

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Pull elbow

  • 2. Case  ผู้ป่วยเด็กชายไทยอายุ5ปี  Chief complain: ปวดข้อศอกซ้าย 2hr PTA  Present illness: 2hr PTAขณะวิ่งเล่นกับเพื่อน แล้วล้มถูกเพื่อน ทับที่ศอกซ้าย เหยียดศอกไม่ได้ งอไม่ได้ เนื่องจาก ปวดมากทันที ข้อศอก บวม ไม่มีบาดแผลภายนอก
  • 3. Primary surway  Airway: can talk no stridor, no c-spine tenderness  Breathing :normal and equal breath sound  Circulation: no active bleed BP 150/80 mmHg HR 112 bpm  Disability: pupil 2 mm RTLBE E4V5M6  Exposure: no back wound
  • 4. Secondary surway  Allergy :ไม่แพ้ยาแพ้อาหาร  Medication:ไม่มียากินประจา  Past history:ไม่มีโรคประจาตัว  Last meal:3 hr PTA  Event: as above
  • 5. Physical exam  V/S BT 36.5c BP 150/80 mmHg RR 20/min PR 112 bpm  elbow in slight flexion and forearm pronated  Left elbow tender at lateral side with limit ROM all direction ,no contusion ,no wound ,no swelling  Shoulder joint not tender full ROM  Can full flexion and extension finger  Radial artery pulse 2+  Intact sensation Lt arm
  • 6. Differential diagnosis  Radial Head subluxation  Supracondylar fractures  Lateral condylar physeal fractures
  • 11. Film Elbow Both elbow AP
  • 12. Film Elbow Both elbow Lateral
  • 13. Nursemaid's Elbow  Also known as subluxation of radial head  Epidemiology  most common in children from 2 to 5 years of age.  Pathophysiology  mechanism  caused by longitudinal traction applied to an extended arm  pathoanatomy  caused by subluxation of the radial head and interposition of the annular (orbicular) ligament into the radiocapitellar joint
  • 14.  PresentationSymptoms  a child with radial head subluxation tends to hold the elbow in slight flexion and the forearm pronated.  Physical Exam  pain and tenderness localized to the lateral aspect of the elbow.
  • 18. video
  • 20.
  • 21.
  • 22. Post treatment  Recurrence occurs in 5% to 39% of cases, but generally ceases after 5 years of age.  immobilization is not necessary and the child may immediately resume use of the arm.  follow up is only needed if the child does not resume normal use of his arm in the following weeks.
  • 23. reference Rockwood and Wilkins Fracture in Children https://www.orthobullets.com/pediatrics/ 4012/nursemaids-elbow